| Payment ID | 7047 |
|---|---|
| Date Created | 08/29/22 2:24 pm |
| Created By | Gloria Jimenez |
| Service Request | |
| Application ID | 1683 |
| Authorization Number | |
| Applicant Information | |
| Name | Sharon King |
| Applicant Email Address | Email hidden; Javascript is required. |
| Unique Identifier | 16171000180 |
| Payment Type | Short-Term Hotel/Motel Stays |
| Payment Details | |
| Receipt Amount | $1,910.54 |
| Receipt Date | 08/25/2022 |
| Comments | hotel stay at Woodspring Suites arrival date is 8/25/2022 departure 9/24/2022 |
| Receipt | 7047-King.pdf |
| Staff Name | Gloria Jimenez |
| Case Manager | AL |
| Verifier Name | Gloria Jimenez |
| Verifier Signature | |
| Date Verified | 08/29/2022 |
